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We need to receive positive reinforcement for accomplishing things, even if we have to give it to ourselves, which is often the case. We're not good at rewarding ourselves and we need to intentionally practice. We can set up rewards as a motivating factor for a specific task. Just the good feeling we get when we do accomplish something is a reward and a positive reinforcement, and it motivates us to do more. When you do accomplish something, take a couple of minutes to admire it and pat yourself on the back before you get distracted and rush off to the next task. If you know your values, you can focus your energy on the things and people that mean the most to you, and make informed choices about what to let go. It's important to stay active when you have pain. Too much rest makes the pain worse, as it can make muscles weaker and joints stiffer. Pacing can help you to find the right balance of activity and rest. Adapting activities in creative ways can make it possible to keep doing the things that matter to you. Do you tell yourself that you are a perfectionist? Do you wear this title like a badge of honor even though it is wrecking your life? You may insist there's a silver lining to the pains you take to be perfect. After all, good things come with a price. Maybe up to now you have been willing to feel disturbed when you, others (especially those you love), or the world fails to be perfect. Maybe you see it as simply the cost of attaining happiness, the welfare of others, or the prosperity of the world in the long run. Maybe you tell yourself this. But where's your proof? How many years have you shaved off of your life "waiting for Godot" like the characters in Samuel Beckett's play--telling yourself there will be a payoff for your perfectionism in some added personal, spiritual, moral, social, human, or even religious value that comes sometime, somewhere, somehow? Of course, you mean well.

You want the best, the absolute best--or damn near it. What's wrong with that? We have a history of failing, of not completing things, or of doing a half-way or a sloppy job. We have many experiences of being criticized, often most severely by ourselves. Therefore if we do get up the motivation and courage to actually try to do something, we'd like to do it perfectly. That would be a way to avoid the criticism and the shame, from others and from ourselves. So we develop perfectionism, which is supposed to be a way to prove that the negative image of us held by others and by ourselves is wrong. For instance, a prominent public speaker I once worked with perceived an increased heart rate, slight sweatiness, and light-headedness before speaking engagements. These feelings caused her to imagine a cascading series of events that would undoubtedly go wrong and ruin her talk and, ultimately, her career. Over the course of several sessions, I was able to help her reinterpret these sensations and come to see them not as anxiety but rather as a kind of anticipatory excitement -- a sign that her body was ramping up to help her put on a dynamic presentation. Reframing her experience as an adaptive response -- rather than a threatening one -- helped her see that her body was actually trying to help her do a good job. Understanding these sensations in a new light enabled her to more effectively focus her mind on the performance she was about to give. Because excitement (along with most heightened emotional states) triggers increased heart rate and respiration, muscle tension, retinal dilation, and increased body temperature, including perspiration, excitement can easily be interpreted by the body as anxiety. This simple reframing intervention did not completely cure my client -- who was struggling with other issues as well -- but it did allow her to more effectively reinterpret and manage the physiological symptoms that were threatening her ability to go on stage. After years of unfulfilling work, she found herself working in palliative care. There she tended to the needs of those who were dying and in doing so transformed her own life. She wrote a blog that was read by more than three million people in its first year about the most common regrets expressed to her by the people she had cared for. By applying the lessons of those nearing their death to her own life, she developed an understanding that it is possible for people to die with peace of mind--if they make the right choices. Here are the top five regrets she learned from the people she cared for as they were dying. They have heavily influenced my own thoughts on living a life of purpose.

I wish I'd had the courage to live a life true to myself, not the life others expected of me. I wish I didn't work so hard. I wish I'd had the courage to express my feelings. I wish I had stayed in touch with my friends. I wish that I had let myself be happier.1 Generally we've learned from an early age that whatever we do is not going to turn out well. We will lose the homework or spill ink on it at the last minute or do the wrong assignment. We will knock over the chair and break the vase, drop the fly ball, and step on our dance partner's foot. We will say the wrong thing in the wrong way at the wrong time. We will try to follow the directions, but when we finish putting it together we will have two extra pieces left over and it won't work. We're going to be laughed at and criticized and picked last for the team. So, we learn, "Why try?" That can lead to procrastination, or it can lead to half-hearted careless rushed attempts that are doomed to failure in a self fulfilling prophecy: "Well, I knew it wasn't going to turn out. At least I didn't put much time into it." It can also lead to perfectionism: "If I can just do it perfectly, then I won't get criticized. I'll show them." We may not be aware of this thinking or this self-talk, but it can be there. Perfectionism leads to procrastination; the job looked big enough to start with, but if it has to be perfect, then it's truly overwhelming. And I'm not going to be able to make it perfect anyway, so this will be another failure. So it's a little difficult to get up the get up to get started. Pain can cause stress, and stress can increase pain. Stress is a normal, healthy part of the human survival system. The right amount of stress can help you do your best work. If you know your signs of stress, you can act early to take care of yourself.

There are many ways to cope with stress, such as movement, relaxation, social support, self-care and making a plan to solve a problem. We'll talk more about how the mind creates your feelings (and can learn to change them) in the next chapter. For now, it's enough to know that every emotion begins with molecular shifts that occur throughout your body as you interact with the outside world. Neuroscientists refer to emotions as molecular action programs. Everything that happens to you, every choice you make, every thought you think, every response you make sends a wash of hormones, neurotransmitters, and other chemicals through your body. An emotion, then, is simply the process of your primitive brain (your limbic system) collecting all this information to allow you to identify the change that has occurred in your physical, psychological, relational, and/or spiritual well-being. Research consistently shows that regular physical activity is one of the best things you can do to manage persistent pain. Starting or maintaining physical activity when pain is present can be a challenge. It can be motivating to remind yourself of the benefits of exercise that are especially important to you. Your demand is also idealistic, which means that it is not realistic--it's either impossible to be satisfied or extremely unlikely. "I have to always be in control"; "I must never make any mistakes"; "People must always agree with me or share my views." Here you harden your preferences for control, flawlessness, agreeability, and compatibility into an unrealizable demand. It is therefore anti-empirical--you do not base your musturbatory, can'tstipated, absolutistic, idealistic demands on evidence. "I need to be loved by everyone." "I must always know the answers to questions that I'm asked." "Others must always meet up to my expectations." But where's the evidence to prove that you actually need to be loved by everyone, that you must know it all, or that others must measure up to your expectations? True, you would prefer these things, but that does not mean that you must have them. Unfortunately, this inference tends to go unnoticed by so many who live in a state of unrelenting stress. But that's a lot of information to gather. The primitive part of your brain responsible for collecting information about the molecular shifts in your body is too unsophisticated to say whether a particular change is good or bad, much less what you should do about it. That job belongs to a much more advanced part of your "thinking brain" called the insular cortex (IC). It's the IC's job to take all the information from the primitive brain about the various micro-shifts constantly occurring in your body and give that constellation of symptoms (heart rate, body temperature, degree of muscle tension, respiration, chemical shifts, etc.) a label that identifies it as a particular emotion. Having labeled it, the IC then sends messages back down to the primitive brain so it can tell your body how to adjust or what behaviors to enact so that you can function most effectively in any given situation.

I believe the best way to live a life without regrets and transform your life through self-care is to embrace your divine purpose. What is great about living your divine purpose is that your cultural background, age, sex, race, religion, or language does not matter. Making physical activity feel safe and enjoyable for you can increase your confidence and motivation. Try some of these strategies to get you started: find the right level of movement, set a goal, track your progress, start low and build up slowly, make adjustments to activities as needed and talk back to difficult thoughts and emotions. Sleep is a complex process. Sleep is regulated by your sleep drive and circadian rhythm. These systems are guided by cues such as light and dark, activity levels and routines. Many people with pain have periods of insomnia. Better sleep quality can lead to having less pain and feeling able to do more activities. There are things you can do to help yourself sleep better such as: sticking to a consistent wake and bed time, avoiding daytime naps and using relaxation strategies. Everyone is born with a special gift and a divine purpose to make a difference in life. Within that purpose is a unique talent just waiting to be explored and expressed. Divine purpose is big. Just stop for a moment, and think about the last time you witnessed someone fulfilling his or her life's purpose. Dotty, the patient I discussed before, started on medication and therapy and had become very enthused as she started feeling better. She was focusing better and was learning new strategies, and she was exercising over three hours a day. That's ADD - we either don't do it at all or we overdo it. She was especially pleased when she lost twenty-five pounds. Then something happened and she stopped her medicine and she stopped her exercise. She came in and reported that she was "back to square one" and that she had gained ten pounds and so she was "a failure".